Provider Demographics
NPI:1831413327
Name:RICHARD RIZZUTO MD PA
Entity type:Organization
Organization Name:RICHARD RIZZUTO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIZZUTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-727-1530
Mailing Address - Street 1:3938 STATE ROAD 64 EAST
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-9059
Mailing Address - Country:US
Mailing Address - Phone:941-746-5900
Mailing Address - Fax:941-746-5922
Practice Address - Street 1:3938 E STATE ROAD 64
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-9059
Practice Address - Country:US
Practice Address - Phone:941-746-5900
Practice Address - Fax:941-746-5922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85272174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2581793OtherUNITED HEALTH CARE
FL276385100Medicaid
FL7772682OtherAETNA
FL01600OtherBLUE CROSS BLUE SHIELD